A nurse is assisting with the plan of care for a client who is Rh+, at 16 weeks of gestation, and scheduled for an amniocentesis. Which of the following actions should the nurse plan to take following the procedure?

A. Discontinue the enema: Mild cramping is a common response during enema administration and does not require stopping the procedure. Discontinuing unnecessarily would prevent the client from receiving the intended therapeutic effect.

B. Slow the rate of instillation: Cramping often occurs when the solution enters the rectum too quickly. Slowing the rate allows the colon to accommodate the fluid more comfortably, reducing discomfort while continuing the enema safely and effectively.

C. Ask the client to hold his breath until the cramping passes: Holding the breath does not relieve rectal cramping and may increase client discomfort or anxiety. Comfort measures should focus on adjusting the procedure rather than altering breathing inappropriately.

D. Pause the enema to administer pain medication to the client: Administering systemic pain medication is unnecessary for mild, transient cramping. Slowing the enema is sufficient to manage discomfort, and pausing for medication would unnecessarily delay treatment.

• Muscle guarding: Muscle guarding is a classic sign of peritoneal irritation, most commonly seen in acute appendicitis. Rebound tenderness and right lower quadrant pain strongly support inflammation of the appendix. Guarding occurs as the abdominal muscles contract to protect inflamed underlying tissue. It is not typically associated with celiac disease and is less characteristic of uncomplicated diverticulitis.
• Increased temperature: Fever reflects an inflammatory or infectious process and is commonly seen in appendicitis and diverticulitis. Both conditions involve localized infection that can progress if untreated. The client’s rising temperature supports acute abdominal inflammation. Celiac disease is an autoimmune condition and does not usually present with fever.
• Nausea and vomiting: Nausea and vomiting frequently accompany appendicitis due to visceral irritation and inflammation. These symptoms can also occur in diverticulitis as a result of bowel inflammation and decreased motility. In contrast, celiac disease more commonly presents with chronic diarrhea and malabsorption rather than acute vomiting.
• Abdominal pain: Abdominal pain is present in all three conditions but differs in character and location. Appendicitis typically causes right lower quadrant pain, while diverticulitis often presents with left lower quadrant pain. Celiac disease can cause diffuse abdominal discomfort related to gluten exposure and malabsorption.
• Elevated WBC count: An elevated white blood cell count indicates an acute inflammatory or infectious process, which is characteristic of appendicitis and diverticulitis. Leukocytosis reflects the body’s immune response to bacterial infection or tissue inflammation. Celiac disease does not typically cause leukocytosis because it is a chronic autoimmune condition rather than an acute infection.